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A review of studies on seminal vesicle motion was performed to improve the understanding of these treatment uncertainties. This will aid planning target volume margin reduction, which is necessary for hypofractionation of high-risk prostate cancer. Embase, Medline, Web of science Core collection, Cochrane CENTRAL register of trials and Google scholar were searched for publications including 3D information on seminal vesicle motion. In total 646 publications were found of which 22 publications were eligible for inclusion. The mean, systematic and random error of inter- and intra-fraction translations are reported, as well as rotations. The translations of the seminal vesicles is smallest in the left–right direction, whereas the rotation was largest around this axis. Although rectal and bladder filling status were the main cause for seminal vesicle motion, no apparent effect on magnitude of motion was seen when different bladder and rectal preparation protocols were used. Inter- and intra-fraction motion of the seminal vesicles is significant. In the studies, systematic and random errors range between 1–7 mm and 1–5 mm respectively, and are largely uncorrelated to prostate motion. The maximum correlation between seminal vesicle and prostate motion was reported with an R2 of 0.7, while 3 other studies report lower and/or non-significant correlations. Five studies report a planning target volume margin of approximately 8 mm. This margin is in line with the results of four relevant dosimetric studies. Mitigating the inter- and intra-fraction motion of the seminal vesicles, including prostate tracking, has the potential to reduce planning target volume margins.

Background Grade groups (GGs) are an important parameter for therapeutic decision making in prostate cancer (Pca) patients. Invasive cribriform and/or intraductal carcinoma (CR/IDC) has an independent prognostic value for disease outcome, but are not included in the GG limiting their clinical use. Objective To perform a proof-of-principle study incorporating CR/IDC in the current GG. Design, setting, and participants All prostate biopsies of 1031 men with screen-detected Pca between 1993 and 2000 were reviewed for the current GG (ranging from 1 to 5) and CR/IDC. The cribriform grade (cGrade) was equal to the GG if CR/IDC was present and GG minus 1 if not. GG1 was cGrade1 if intraductal carcinoma was absent. Intervention Biopsy review for GG and CR/IDC. A total of 406 patients had received radical prostatectomy (RP), 508 radiotherapy (RT), 108 surveillance, and eight hormonal therapy, and the treatment was unknown for one patient. Outcome measurements and statistical analysis disease-specific survival (DSS), metastasis-free survival (MFS), and biochemical recurrence–free survival (BCRFS) after 15.1 yr (interquartile range 10.9–19.7 yr) follow-up were compared using Harrell's C-statistic. Results and limitations The biopsy GGs were 486 GG1, 310 GG2, 104 GG3, 64 GG4, and 67 GG5; cGrade distributions were 738 cGrade1, 102 cGrade2, 91 cGrade3, 58 cGrade4, and 42 cGrade5. The cGrade had a better discriminative value than the GG for DSS (C-index 0.79; 95% confidence interval 0.74–0.83 vs 0.76; 0.71–0.82) and MFS (0.79; 0.74–0.84 vs 0.77; 0.72–0.82). The discriminative value for BCRFS after RP and RT was similar for both models. Different diagnostic, such as use of sextant biopsies, and therapeutic strategies in the 1990s are the limitations of this study. Conclusions The cGrade is a simple Pca grade modification with better discriminative values for DSS and MFS than the GG, particularly impacting decision making in men with current GG2 Pca. Patient summary Microscopic grading is an important factor for decision making in prostate cancer (Pca) patients. We show that a simple grade modification better predicts Pca outcome and might improve treatment choices.

Purpose: The phase 3 Hypofractionated Irradiation for Prostate Cancer trial compared hypofractionated radiation therapy with conventionally fractionated radiation therapy in patients with localized prostate cancer. Similar 5-year relapse-free survival rates were achieved in both groups, but noninferiority of hypofractionation was not confirmed for genitourinary and gastrointestinal toxicity. Here, we present the secondary trial endpoint on patient-reported quality of life. Methods and Materials: A total of 820 patients with intermediate-risk or high-risk prostate cancer were randomized to hypofractionation (19 fractions of 3.4 Gy) or conventional fractionation (39 fractions of 2.0 Gy). Quality of life was measured using a validated questionnaire, the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Prostate Cancer 25 module. Subscales (score range, 0-100) on urinary symptoms, gastrointestinal symptoms, symptoms related to androgen deprivation therapy, sexual function, and sexual activity were analyzed. Changes from baseline of at least 5 points were considered clinically relevant. Inferiority of hypofractionation for separate subscales was rejected if the mean difference in the 3-year incidence of clinically relevant deterioration between treatments was

Relative increase of grade 4 and presence of invasive cribriform and/or intraductal carcinoma have individually been associated with adverse outcome of Gleason score 7 (GS 7) prostate cancer. The objective of this study was to investigate the relation of Gleason grade 4 tumor percentage (%GG4) and invasive cribriform and/or intraductal carcinoma in GS 3+4=7 prostate cancer biopsies. We reviewed 1031 prostate cancer biopsies from the European Randomized Study of Screening for Prostate Cancer. In total 370 men had G3+4=7. The relation of invasive cribriform and/or intraductal carcinoma and %GG4 with biochemical recurrence-free survival (BCRFS) after radical prostatectomy (n=146) and radiation therapy (n=195) was analyzed using Cox regression. Invasive cribriform and/or intraductal carcinoma occurred in 7/121 (6%) patients with 1-10% GG4, 29/131 (22%) with 10-25%, and 52/118 (44%) with 25-50% GG4 (P

Androgen-deprivation therapy was shown to improve treatment outcome of external beam radiation therapy (EBRT) for locally advanced prostate cancer (PCa). DNA damage response (DDR) was suggested to play a role in the underlying mechanism, but conflicting results were reported. This study aims to reveal the role of the androgen receptor (AR) in EBRT-induced DDR and to investigate whether next-generation AR inhibitor apalutamide can radiosensitize PCa. PCa cell lines and tissue slices were treated with anti-androgen alone or combined with EBRT. The effect of treatments on cell growth, tissue viability, DDR, and cell cycle were investigated. RAD51 and DNA-dependent protein kinase catalytic subunit (DNA-PKcs) levels were determined by Western blotting. Homologous recombination (HR) capacity was measured with the directed repeats-green fluorescent protein (DR-GFP) assay. We report the radiosensitizing effect of anti-androgens, which showed synergism in combination with EBRT in AR-expressing tumor slices and cell lines. Moreover, a compromised DDR was observed in AR-expressing cells upon AR suppression. We found that AR inhibition downregulated DNA-PKcs expression, resulting in reduced non-homologous end-joining repair. DDR through HR was a secondary effect due to cell-cycle change. These data provide a mechanistic explanation for the combination regimen and support the clinical use of apalutamide together with EBRT for localized PCa patients.

In Europe, most greenhouse vegetable crops are grown in soil. Where soilless systems are used, apart from in The Netherlands, Belgium and France, they are mostly free-draining systems, in which nutrient solutions are not recirculated. Both soil-grown and free-draining soilless systems commonly have large nitrate (NO3−) leaching loss. Irrigation is a major contributing factor to NO3− leaching loss. Irrigation management of greenhouse vegetable crops needs to be improved to reduce the appreciable N loss to subterranean water and surface water bodies. This article reviews the state-of-the-art, of methods and tools that are available, or are being developed, to optimise irrigation management of both soil- and soilless-grown vegetable crops in greenhouses. Adaptions for greenhouse conditions and cropping cycles of the FAO56 approach to calculate crop water requirements are reviewed. Attention is paid to (i) the developments and suitability of various adaptations of the Penman–Monteith FAO56 equation and simpler equations to calculate reference crop evapotranspiration (ETO), and (ii) equations to calculate crop coefficient (Kc) values under greenhouse conditions, in which cropping cycles may differ appreciably from those of outdoor crops. The various classes of soil/substrate moisture sensors that have been used in greenhouse crops are reviewed, regarding their general suitability and practical use. Their use in both soil and substrate is considered, as are the effects of salinity and the use of some sensors to measure the salinity of the growing media. The use of various plant sensors with vegetable crops under greenhouse conditions is reviewed. The results of a survey that assessed, for greenhouse vegetable crops in Europe, the use of different (a) types of irrigation systems, and (b) irrigation management methods, for both soil and soilless production are presented. Following the revision of this information, recommendations are made regarding the scientific and practical value of the available tools and technologies to aid growers to optimise irrigation management of vegetable crops grown in greenhouses.

Summary Background Studies have reported a low α/β ratio for prostate cancer, suggesting that hypofractionation could enhance the biological tumour dose without increasing genitourinary and gastrointestinal toxicity. In the multicentre phase 3, HYpofractionated irradiation for PROstate cancer (HYPRO) trial, hypofractionated radiotherapy was compared with conventionally fractionated radiotherapy for treatment of prostate cancer. We have previously reported acute and late incidence of genitourinary and gastrointestinal toxicity; here we report protocol-defined 5-year relapse-free survival outcomes. Methods We did an open-label, randomised, phase 3 trial at seven Dutch radiotherapy centres. We enrolled patients with intermediate-risk to high-risk T1b–T4NX–N0MX–M0 localised prostate cancer, a prostate-specific antigen concentration of 60 μg/L or less, and a WHO performance status of 0–2. We used a web-based application to randomly assign (1:1) patients to either hypofractionated radiotherapy of 64·6 Gy (19 fractions of 3·4 Gy, three fractions per week) or conventionally fractionated radiotherapy of 78·0 Gy (39 fractions of 2·0 Gy, five fractions per week). Based on an estimated α/β ratio for prostate cancer of 1·5 Gy, the equivalent total dose in fractions of 2·0 Gy was 90·4 Gy for hypofractionation compared with 78·0 Gy for conventional fractionation. The primary endpoint was relapse-free survival. All analyses were done on an intention-to-treat basis in all eligible patients. The HYPRO trial completed recruitment in 2010 and follow-up is ongoing. This trial is registered with ISRCTN, number ISRCTN85138529. Findings Between March 19, 2007, and Dec 3, 2010, 820 patients were enrolled, of whom 804 were eligible and assessable for intention-to-treat analyses. Of these, 407 were assigned hypofractionated radiotherapy and 397 were allocated conventionally fractionated radiotherapy. 537 (67%) of 804 patients received concomitant androgen deprivation therapy for a median duration of 32 months (IQR 10–44). Median follow-up was 60 months (IQR 51–69). Treatment failure was reported in 169 (21%) of 804 patients, 80 (20%) in the hypofractionation group and 89 (22%) in the conventional fractionation group. 5-year relapse-free survival was 80·5% (95% CI 75·7–84·4) for patients assigned hypofractionation and 77·1% (71·9–81·5) for those allocated conventional fractionation (adjusted hazard radio 0·86, 95% CI 0·63–1·16; log-rank p=0·36). There were no treatment-related deaths. Interpretation Hypofractionated radiotherapy was not superior to conventional radiotherapy with respect to 5-year relapse-free survival. Our hypofractionated radiotherapy regimen cannot be regarded as the new standard of care for patients with intermediate-risk or high-risk prostate cancer. Funding Dutch Cancer Society.

Globe artichoke is cultivated for its flower heads and as the source of pharmaceutical compounds from the leaves, whose extracts contain a high level of health-promoting compounds and show one of the highest antioxidant capacities reported for vegetables. The content and composition of such beneficial plant secondary metabolites may be greatly affected by cultivation variables, including plant genotype and mycorrhizal symbiosis. This study was carried out to gain knowledge on antioxidant activity, total phenols and chlorogenic acid levels in the leaves of two artichoke cultivars, Romanesco and Tema, as affected by six arbuscular mycorrhizal fungi (AMF) belonging to diverse genera, species and isolates. The six AMF showed significantly higher percentages of root colonization in Romanesco (46 %) than in Tema (32 %), and different colonization dynamics. The overall pooled data showed that in Romanesco the levels of total phenols increased by 35 %, chlorogenic acid by 67 % and antioxidant activity by 43 %, compared with Tema. The six AMF differentially affected such levels, with Claroideoglomus claroideum 22W3 as the only isolate producing significant increases compared with controls, for total phenols and chlorogenic acid, and with C. claroideum 22W3 and Funneliformis mosseae IMA1 as the isolates enhancing antioxidant activity, compared with controls. Moreover, a strong correlation was found between total phenols and antioxidant activity in the leaves of both artichoke cultivars. This work, comparing the highest number of diverse AMF studied so far in relation to their modulation of plant secondary metabolism, expanded our knowledge on their functional diversity and allowed the detection of the best performing symbionts to be utilized for obtaining artichoke leaves with enhanced health-promoting activities.

The production of a compost from olive wet husks is described. The process is enhanced through the use of starters prepared with virgin husks enriched with selected microbial cultures. This approach, with respect to composting without the use of starters, allows to achieve faster start of the process (10 vs. 45 days), deeper humification (humification rate 19.2 vs. 12.2), shorter maturation time (2 vs. 4–5 months) and better detoxification of the starting material. Furthermore, the compost produced can effectively substitute for turf as a cultivation substrate in horticulture at greenhouse level, with beneficial effects on nutraceutical traits of tomato fruits.

A composite model was developed for water and mineral relations of greenhouse tomato (Solanum lycopersicum L.) cultivated in semi-closed or open soilless (rockwool) culture. The model simulated on a daily basis: (i) the evolution of crop leaf area index and water uptake using empirical equations; and (ii) the variations of ion concentrations and electrical conductivity (EC) in the recirculating or drainage nutrient solution using a mass balance equation based on the concept of ion uptake concentration. The model was calibrated using measured data collected in previous works and validated in two independent experiments carried out in 2005 and 2007. In these experiments, different fertigation strategies were tested using nutrient solutions prepared with saline (9.5molm^-^3 NaCl) water. In semi-closed systems, the recirculating nutrient solution was discharged whenever EC exceeded a pre-defined threshold (4.5, 6.5 or 7.5dSm^-^1, depending on the experiment) and/or nitrate (NO"3^-) concentration was lower than 1.0molm^-^3. This value was selected because 20mgL^-^1 (1.43molm^-^3) is the limit imposed to NO"3^- concentration of wastewater discharged into surface water by the current Italian legislation. In open system, the crop was irrigated with full-strength nutrient solution without recirculation of drainage water. In both years, fertigation strategy did not affect significantly crop growth, fruit yield and water uptake. In most cases, simulations of seasonal crop water uptake were within the confidence interval of the measurements with a maximum deviation of -6%. The model predicted acceptably the time course of EC and ion concentration in recirculating (semi-closed systems) or drainage (open system) nutrient solution. A moderate discrepancy between observations and simulations was found for NO"3^- concentration, especially during the first weeks after planting. In general, there was a good agreement between simulated and measured values of total water and nitrogen (N) use. In 2005, simulated values of N uptake in semi-closed systems were -11% to +5% of measured values. Prediction of N uptake was less accurate in 2007, when simulated values were +17% of measured values. In open system, the model underestimated N uptake (-17%) mainly due to overestimation of N leaching (+6%). Applications of the composite model for operative management of soilless culture and for scenario analysis are discussed.

Purpose: To assess the impact of dose escalation of radiotherapy on quality of life (QoL) in prostate cancer patients. Patients and Methods: Three hundred prostate cancer patients participating in the Dutch randomized trial (CKTO 69-10) comparing 68 Gy with 78 Gy were the subject of this analysis. These patients filled out the SF-36 QoL questionnaire before radiotherapy (baseline) and 6, 12, 24, and 36 months thereafter. Changes in QoL over time of >= 10 points were considered clinically relevant. Repeated-measures regression analyses were applied to estimate and test the QoL changes over time, the differences between the two arms, and for association with a number of covariates. Results: At 3-year follow-up, the summary score physical health was 73.2 for the 68-Gy arm vs. 71.6 for the 78-Gy arm (p = 0.81), and the summary score mental health was 76.7 for the 68-Gy arm vs. 76.1 for the 78-Gy arm (p = 0.97). Statistically significant (p < 0.01) deterioration in QoL scores over time was registered in both arms in six scales. The deterioration over time was more pronounced in the high-dose arm for most scales. However, clinically relevant deterioration (> 10 points) was seen for only two scales. None of the tested covariates were significantly correlated with QoL scores. Conclusion: Dose escalation did not result in significant deterioration of QoL in prostate cancer patients. In both randomization arms, statistically significant decreases in QoL scores over time were seen in six scales. The deterioration of QoL was more pronounced in the physical than in the mental health domain and in some scales more in the high- than in the low-dose arm, but the differences between arms were not statistically significant. (C) 2011 Elsevier Inc.

In the spring-summer season of 2005 and 2006, we explored the influence of three fertigation strategies (A–C) on the water and nitrogen use efficiency of semi-closed rockwool culture of greenhouse tomato conducted using saline water (NaCl concentration of 9.5 mol m−3). The strategies under comparison were the following: (A) crop water uptake was compensated by refilling the mixing tank with nutrient solution at full strength (with the concentrations of macronutrients equal or close to the corresponding mean uptake concentrations as determined in previous studies) and the recirculating nutrient solution was flushed out whenever its electrical conductivity (EC) surpassed 4.5 dS m−1 due to the accumulation of NaCl; (B) the refill nutrient solution had a variable EC in order to maintain a target value of 3.0 dS m−1; due to the progressive accumulation of NaCl, the EC and macronutrient concentrations of the refill nutrient solution tended to decrease with time, thus resulting in a progressive nutrient depletion in the recycling water till N–NO3− content dropped below 1.0 mol m−3, when the nutrient solution was replaced; (C) likewise Strategy A, but when EC reached 4.5 dS m−1, crop water uptake was compensated with fresh water only in order to reduce N–NO3− concentration below 1.0 mol m−3 before discharge. In 2005 an open (free-drain) system (Strategy D), where the plants were irrigated with full-strength nutrient solution without drainage water recycling, was also tested in order to verify the possible influence of NaCl accumulation and/or nutrient depletion in the root zone on crop performance. In the semi-closed systems conducted following strategies A, B or C, the nutrient solution was replaced, respectively, 10, 14 and 7 times in 2005, and in 19, 24 and 14 times in 2006, when the cultivation lasted 167 days instead of 84 days in 2005. In both years, there were no important differences in fruit yield and quality among the strategies under investigation. Strategy C produced the best results in terms of water use and drainage, while Strategy B was the most efficient procedure with regard to nitrogen use. In contrast to strategies A and D, the application of strategies B and C minimized nitrogen emissions and also resulted in N–NO3− concentrations in the effluents that were invariably lower than the limit (approximately 1.42 mol m−3) imposed to the N–NO3− concentration of wastewater discharged into surface water by the current legislation associated to the implementation of European Nitrate Directive in Italy.

Purpose: To analyze the correlation between dose-volume parameters of the corpora cavernosa and erectile dysfunction (ED) after external beam radiotherapy (EBRT) for prostate cancer. Methods and Materials: Between June 1997 and February 2003, a randomized dose-escalation trial comparing 68 Gy and 78 Gy was conducted. Patients at our institute were asked to participate in an additional part of the trial evaluating sexual function. After exclusion of patients with less than 2 years of follow-up, ED at baseline, or treatment with hormonal therapy, 96 patients were eligible. The proximal corpora cavernosa (crura), the superiormost 1-cm segment of the crura, and the penile bulb were contoured on the planning computed tomography scan and dose-volume parameters were calculated. Results: Two years after EBRT, 35 of the 96 patients had developed ED. No statistically significant correlations between ED 2 years after EBRT and dose-volume parameters of the crura, the superiormost 1-cm segment of the crura, or the penile bulb were found. The few patients using potency aids typically indicated to have ED. Conclusion: No correlation was found between ED after EBRT for prostate cancer and radiation dose to the crura or penile bulb. The present study is the largest study evaluating the correlation between ED and radiation dose to the corpora cavernosa after EBRT for prostate cancer. Until there is clear evidence that sparing the penile bulb or crura will reduce ED after EBRT, we advise to be careful in sparing these structures, especially when this involves reducing treatment margins. (c) 2008 Elsevier Inc.

Quality of life in general and sexual functioning in particular has become very important in cancer patients. Biological factors such as anatomic alterations, physiological changes and secondary effect of medical interventions may preclude normal sexual functioning even when sexual desire is intact. In spite of modern surgical techniques, improved chemotherapeutical drugs and sophisticated radiation techniques, still many patients complain of impaired sexual function after cancer treatment. A large number of instruments already exist to assess quality of life in cancer patients. It is important to standardize procedures and to use validated questionnaires. Collecting data on an ongoing basis before and long after treatment is mandatory, and control groups must be used. Patients should be offered sexual counseling and informed about the availability of therapies for sexual dysfunctions. In this paper, we review the topic of sexual functioning after treatment of the most common malignancies in men (except prostate cancer) and give suggestions for treatment.

The paper reports an aggregated model for the water requirements (W) of greenhouse tomato grown in spring or summer�autumn season in closed (recycling nutrient solution) rockwool culture. A series of experiments were conducted between 2000 and 2003. In each experiment, two different nutrient solution treatments were established in a randomized block design, with three replicates. The nutrient solutions differed only for the concentration of NaCl and the electrical conductivity (EC), which were, respectively, 10 mol m-3 and 3.0 dS m-1 in T10 treatment, and 20 mol m-3 and 3.9 dS m-1 in T20 treatment. Fruit yield was 10.1 ± 0.3 and 9.6 ± 0.2 kg m-2 in T10 and T20 treatments, respectively, and the difference was not significant. Two diverse sub-models were developed, for the daily crop water uptake (WU) and for the leaching requirement (LR) in dependence of a maximum tolerable sodium (Na+) concentration in the recycling nutrient solution. WU was simulated using a simple regression model, which considered the radiation actually intercepted by the crop. The determination coefficient for the linear regression between predictions (P) and measurements (M) of daily WU was 0.853 (n = 581), with the slope (0.963) and the intercept (-0.053) of the linear regression not significantly different, respectively, from 1 and 0. There was a good agreement between P and M values of WU, with a mean deviation between P and M of 2 ± 10%. The modelling of LR was less satisfactory, especially in spring crops; the average value for P and M values of LR was 0.30 and 0.28, respectively. The P�M residual averaged 11 ± 25% for LR and 13 ± 26% for the volume of drainage water or runoff (WR). Nevertheless, the aggregated model accounted well for W with an average deviation of 4 ± 11% between P and M. The sensitivity analysis showed the great influence of radiation on W and suggested that the quality of irrigation water (namely, NaCl concentration) is more relevant for crop water use efficiency than any other factor considered by the LR model, including the affinity of the plant for the salts contained in the nutrient solution.

Objectives To compare sexual functioning and quality of life of patients with cervical cancer after non-surgical treatment with a control group of healthy women. Methods Women treated for cancer of the cervix were selected out of an existing database and interviewed using a validated questionnaire, the Female Sexual Function Index (FSFI). Women had undergone radiotherapy or a combination therapy (radiotherapy and chemotherapy and/or hyperthermia). The two treatment groups and the control group were compared with respect to quality of life and sexual functioning. Results Seventy-six women (27 after radiotherapy alone, 33 after radiotherapy with either chemotherapy or hyperthermia and 16 healthy women) were included in this analysis. Women who were treated for carcinoma of the cervix experienced a lower quality of life, reported more physical complaints, had more sexual problems and less sexual intercourse than healthy women. Compared to the radiotherapy group, 20% more patients in the combination therapy group were sexually active. Conclusions Women who underwent non-surgical treatment for carcinoma of the cervix had more sexual problems and less sexual intercourse than healthy women, irrespective of the treatment modality used (radiotherapy or combination therapy). Prospective studies on sexual functioning after treatment with radiotherapy versus combination therapies are needed.

Background Clinically localised prostate cancer can be treated with various modalities after which there are a comparable overall survival. In this study the sexual function and quality of life was evaluated in patients treated with brachytherapy combined with external beam radiotherapy (EBRT). Patients and methods One hundred and eleven patients with clinically localised prostate cancer were treated with HDR-Ir-192 brachytherapy in combination with EBRT from February 2000 to August 2003. An interview was conducted consisting of a questionnaire based on the International Index of Erectile Function (IIEF) and the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30, concerning erectile function and quality of life. Results One hundred and three (96%) men consented for interview. The mean time following treatment was 28 months (range 6–36). Thirty-six men (35%) had normal erections at the time of interview, 23 men (22%) had no erections, 25 (25%), had variable erections whilst sexually active. Thirty men (29%) had had successful penetrative sexual intercourse in the 4 weeks preceding the interview each time they had attempted to do so. A further 15 (15%) had mostly successful penetration whenever they had tried during the previous 4 weeks. Nine (9%) had been unable to achieve penetration and 45 men (44%) had made no attempt at penetration. Importantly, 81 men (79%) indicated that their sexual function overall was reduced in comparison to the situation before treatment. Twenty-two men (21%) stated that their sexual function was unchanged and no man found that there had been an improvement as compared to pre-treatment. Conclusion A reasonable number of men (60%) had erections of variable quality at the time of interview following treatment. However, 79% of men stated that their overall level of sexual function was reduced post-treatment. We have insufficient comparative baseline data to enable us to make a direct comparison between pre- and post-treatment sexual function. Patients rated their general level of health and quality of life as good following treatment.

The number of patients diagnosed with early stage prostate cancer (PC) has increased dramatically, because of routine prostate-specific antigen testing in the recent years and the possibility for cure of early disease. Radiation therapy is together with radical prostatectomy the most effective treatment for localized disease. Incidence of erectile dysfunction (ED) after radiotherapy (RT) reported in the literature vary from 6% to 84% after external-beam RT to 0–51% after brachytherapy. Most of these studies are retrospective, the definition of ED is variable and sexual functioning is frequently assessed by asking only one question. Already in the 1980s it was suggested that post-radiation ED was attributable to vascular damage. More recently, a strong relationship between radiation dose and volume of the penile bulb has been found. Though, a multifactorial etiology has to be considered taking into account pre-treatment erectile function. If radiation induces vascular damage that causes ED, any means of reducing the dose to the pelvic vascular structures would likely decrease ED. Patients need to be informed about the availability of effective treatments such as PDE5-I, intracavernosal injection and vacuum devices.

In closed-loop soilless culture, one of the most relevant problems may be the accumulation in the recirculating nutrient solution of ions contained in irrigation water that are not or scarcely absorbed by the plants (e.g. Na, Cl) In order to verify the possibility to reduce the rate of recirculating water salinisation by means of subirrigation, an experiment was carried out in the spring of 2002 and 2004, with tomato plants (cv. Jama) grown in glasshouse and watered by conventional drip irrigation (D) or by subirrigation (trough bench system; S). The plants were cultivated in pots filled with a peat-perlite substrate for approximately 3 months and fed with complete nutrient solution, which was prepared with fresh water containing 10 mol m−3 NaCl; the nutrient solution in the collecting tank was replaced when the value of electrical conductivity (EC) exceeded 6.0 dS m−1. Water and nutrient crop use, salt accumulation in the substrate, and fruit yield were monitored. In S culture, the composition and EC of the recirculating nutrient solution changed slightly, while in D treatment there was a fast water salinisation that made it necessary to flushed out the nutrient solution in six different occasions, with consequent loss of water and fertilisers. In S culture, the upward water movement in the substrate, coupled with selective mineral uptake by the roots, caused salinity build-up in the upper region of the substrate, which was associated with Na+ accumulation. No significant influence of irrigation methods on fruit yield and quality was observed. These findings suggest that subirrigation can be a tool to reduce the water consumption and nutrient runoff in closed-loop substrate culture of tomato conducted with saline water.

Objectives. To determine the efficacy of sildenafil citrate (Viagra) in patients with erectile dysfunction after three-dimensional conformal external beam radiotherapy for prostate cancer. Methods. Sixty patients treated with radiotherapy for prostate cancer at least 6 months previously, complaining of erectile dysfunction, and not using nitrates were entered into a double-blind, placebo-controlled, crossover study lasting 12 weeks. They received 50 mg of sildenafil or placebo for 2 weeks; at week 2, the dose was increased to 100 mg in the case of an unsatisfactory erectile response. At week 6, patients crossed over to the alternative treatment. Patients were then allowed to enter a 6-week open-label phase using 50 mg of sildenafil in the first 2 weeks, increasing the dose to 100 mg in the case of an insufficient erectile response in the following 4 weeks. Data were collected before trial entry (baseline evaluation) and every 2 or 4 weeks using the International Index of Erectile Function questionnaire. Any side effects were recorded. Two years later, all patients were approached by mail to evaluate their current sexual functioning and possible use of sildenafil. Results. All patients completed the double-blind, crossover study. For nearly all the International Index of Erectile Function questions, sildenafil caused a significant increase in mean scores from baseline. Placebo had no effect. Seventy-seven percent entered the open-label phase; they were the better responders in the double-blind phase. Sildenafil was as equally effective as in the double-blind phase. The side effects were mild or moderate and significantly decreased in the open-label period. Two years after trial entry, 24% still used sildenafil. Conclusions. Sildenafil is relatively effective in patients with erectile dysfunction after three-dimensional conformal external beam radiotherapy for prostate cancer. New drugs and combination therapies are needed to improve outcome.

Purpose: To analyse retrospectively treatment outcome in patients irradiated for Peyronie’s disease. Methods and Materials: The records of 179 patients, median age 52 years, that received radiotherapy (RT) between 1982 and 1997 were reviewed. 78% presented with painful erections and 89% with penile deformity. The symptoms were present for a median duration of 6 months (range, 1–72 months). The RT schedule consisted of 13.5 Gy (9 × 1.5 Gy, 3 fractions per week) using orthovoltage X-rays in 123 patients or 12 Gy (6 × 2 Gy, daily fractions) using electrons in 56 patients. A questionnaire regarding current sexual functioning was mailed to 130 patients whose addresses could be traced; 106 (82%) responded. Results: At mean follow-up period of 3 months, 83% reported that pain was diminished or had disappeared after RT. Twenty-three percent of patients reported a decrease in penile deformity. Following RT, surgical correction of penile curvature was performed in 29% of patients. No RT-related complications occurred except transient dysuria in 1 patient. Questionnaire data: 72% of patients were currently sexually active, 48% had erectile dysfunction, and 49% expressed dissatisfaction with their current sexual functioning. Conclusion: Low-dose external RT (12–13.5 Gy) results in relief of pain in the majority of patients with Peyronie’s disease. Improvement in penile deformity was observed, avoiding surgery in a number of patients. No significant RT-associated morbidity was encountered. It is disappointing that almost 50% of patients complain of sexual functioning, but this is presumably not related to radiotherapy.